Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Monday, November 05, 2007

Walk of Life

[It's another testament to the universality of rock and roll that the lyrics of the title-referenced song make mention of a "song about a knife." And may I add that when presenting my biology honors thesis in college, the subject of which was intra-allelic recombination in the Ruby Eye locus of D. Melanogaster, the results of my inquiry into which were sorta surprising, I made another musical reference. "The fact," I said, "that Ray Charles, when he sang 'They say, Ruby you're like a dream, not always what you seem,' predicted the very results I am about to reveal says much not only about Mr. Charles in particular but about popular music in general." So we have a pattern here. And I'll just assume that everyone recognizes the picture.]

During the planning stages of the surgery center in the creation of which I was a proud participant, it came to be revealed that we'd be having the patients walk into the OR under their own power. No gurneys, no wheelchairs. You walk, we'll carry the IV bag (or wait till you're in there to start it.) Being well into my career by that time, and having worked in a few previous surgery centers -- not to mention oodles of ORs of the olden ouvre -- I was surprised. Weirded out, even. Likewise, I figured, our prospective patients. On several levels, I was wrong. It is, after all, ambulatory surgery.

Outpatient surgery is all about the "out." To wake up quickly, and to be clear-headed when doing so, the less extraneous drugs the better. Sedation of the pre-op variety can add to time in the recovery room. If you're marching, you're not medicated. There's more to it, though. Walking to the OR sends a homey message: it's like coming into someone's house. Hi there, welcome. I'm Cindy, and this is Jane. It's unthreatening; there's some retention of control, of doing instead of being done to. And best of all, it gives those veins in the legs a final squeeze at the best time: right before lying motionless for a while and going all thrombogenic.

In medicine, involving, as it does, humans, nothing is 100%. The stroll is not for everyone. Some people, medically or emotionally, need that sedation going in. And to make it a tolerable trek, you need to attend to certain potential gaps in coverage. Still, I rapidly came around to liking everything about walking to the room. And with a nice robe, a few smiles on arrival, and a quick and comfortable exit, it's my perception that the patients did, too. I can't count how many times I heard from patients on their post-op visit, within a couple of words of verbatim, "I never thought I'd say this about having surgery, but that was a wonderful experience." A great facility and a superb staff had, of course, much to do with it (as did receiving a perfect operation!) But the walk, I think, played a part. And the rose petals we strewed along the path.

I had surgery a couple years ago, and I was rolled into the room without any sedation because we had to get a final bit of information from the surgeon for the documents I had to sign. I have to tell you, I was absolutely terrified once I looked around and saw all the lights and instruments and the things my arms would be strapped to. It was a very unpleasant experience. Even just seeing these people (nurses and anesthesiologist) I had never met before wearing their masks kind of made it like a horror movie. What looks like everyday equipment to medical professionals looks pretty scary to patients. If I ever have surgery again (and I hope I don't, of course) I hope I can do it with sedation before. I still get a little freaked out thinking about it.

Yikes!! Hey, that may be good for some people, but in neither of my experiences was I in any condition to be walking into the OR. The second time (which was recent enough that I actually remember), I was wigged out enough without being fully conscious. I was still aware enough when I got there to get a general look around, which I thought was rather cool, but I was definitely relieved when the sedation kicked in before my surgeon showed up. It was kind of freaky to realize that some of the stereotypes people have of surgery and its general milieu are actually true. I was just wishing I was on the OTHER side of that narrow table...I would have been much happier as the surgeon than as the patient!

In these days of so many medical dramas on TV, there would be I think little unfamiliar to most people about what ORs look like. Walking in would give them that familiar camera perspective they see all the time, plus the opportunity for the various staff to introduce themselves with everyone in the upright position.

You know my thoughts on pre-anesthesia...concerns about being too breezy with the mouth. Walking in without the drugs sounds good. :)

I have never been afraid of the OR or staff...or hospitals for that matter.Yes, I have been concerned or even afraid of the surgery and outcome but never the actual staff or OR. Sometimes people equate hospital settings with death and doom but I always see them as help and rescue...your going to feel better. The only time I was freaky about it was when I was being advised to have the high risk surgery that I ended up not needing after all.

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.